Adrenal Surgery – New relatively painless technique for removing adrenal tumours
Adrenal surgery has been revolutionised with the advent of PRA, or posterior retroperitoneoscopic adrenalectomy.
Dr. Miller has learned this procedure directly from Dr. Martin Walz, the famous German surgeon who invented it. In May 2011 she became the first surgeon in Victoria to perform the procedure. In PRA, the adrenal tumour is removed via three tiny incisions in the back. Most patients never require anything more than panadol to relieve discomfort.
The PRA approach to the adrenal is a major improvement over open or laparoscopic adrenal surgery. Even with laparoscopic adrenal surgery, patients are typically on prescription pain medicine for a week or more. PRA is appropriate for adrenal tumours up to 6cm diameter and virtually all patients can go home comfortably the morning after surgery.
Dr. Miller's introduction of this new procedure to Victoria was covered on ABC radio and in the Herald Sun Newspaper.
The adrenal glands sit above the kidneys and make hormones such as adrenaline, aldosterone, and cortisol. Adrenal tumours are quite common, but most don't require surgery. Indications for surgery include tumour size >4cm, suspicion of cancer, or if the tumour is making too much of hormone: adrenaline (pheochromocytoma), aldosterone (Conn's syndrome), or cortisol (Cushing's syndrome.)
Cortical sparing adrenalectomy, or partial adrenalectomy, is a technique to remove an adrenal tumour, while leaving normal adrenal tissue in place. This technique is especially important for selected patients with hereditary and adrenal tumour syndromes, such as MEN 2 and Von Hippel Lindau Syndrome, or patients who have tumours on both adrenals.
Previously, patients who had tumours in both adrenal glands had both adrenals fully removed. After this, the patient will permanently need adrenal replacement therapy for life, and need to remember to increase their dose during periods of illness or trauma. Patients can live normal lives this way. There is about a 35% chance of future hospital admissions for “Addisonian Crisis,” when the medication dose is insufficient in times of stress.
With cortical sparing adrenalectomy, most patients (75-80%) will have enough normal adrenal tissue to sustain them without requiring medication. The tradeoff is a slightly higher risk of disease recurrence.
Cortical sparing adrenalectomy is appropriate for some patients with:
Hereditary pheochromocytoma syndromes
Solitary adrenal metastases
Bilateral aldosterone secreting tumours
Benign adrenal tumour with previous adrenal already removed.
Dr. Miller is experienced with cortical sparing adrenalectomy, and can discuss with you whether it is right for you.
Walz, et al: Partial vs Total Adrenalectomy by the Posterior Retroperitoneoscopic Approach: Early and Long-term Results of 325 Consecutive Procedures in Primary Adrenal Neoplasia
World J Surg 2004. 28, 1323-1329
Asari, et al: Estimated Risk of Pheochromocytoma Recurrence After Adrenal-Sparing Surgery in Patients with MEN Type 2A.
Archives of Surgery 2006. 141:1199-1205
Diner, et al: Partial Adrenalectomy: The National Cancer Institute Experience.
Urology, 2005. 66: 19-23
Alesina, et al: Minimally invasive cortical-sparing surgery for bilateral pheochromocytomas.
Langenbecks Arch Surg, 2012. 397: 233-238
Grubbs, et al: Long-Term Outcomes of Surgical Treatment for Hereditary Pheochromocytoma. Journal of the American College of Surgeons, 2013. 216:280-289.
A/Prof Julie Miller talks Posterior Retroperitoneoscopic Adrenalectomy (PRA)